AFH Documents
All Documents Will Be Emailed Within 24hr & Customized Will Be Emailed Within 48hr
Name of Requester
*
First Name
Last Name
E-mail To Send Documents
*
example@example.com
Phone Number
*
Pay Method
*
Please Select
Zelle (leapwayllc@gmail.com)
Apple Pay (414-526-8985)
Cash App ($seductive414)
CC/ Debit Card
Afterpay
Documents Requesting
*
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Program Statement
$
60.00
Quantity
1
2
3
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5
6
7
8
9
10
Customized Program Statement
Includes Your Logo Added, Business Name, Address, Number of Beds & Type Of Clients, House Description
$
80.00
Quantity
1
2
3
4
5
6
7
8
9
10
Admission Agreement
$
70.00
Quantity
1
2
3
4
5
6
7
8
9
10
Customized Admission Agreement
Include Your Logo & Business Name
$
90.00
Quantity
1
2
3
4
5
6
7
8
9
10
Client Admission Documents
All Forms Required To Admit A Client And Required To Be In Client Folder. Also Some Forms Will Need To Be Submitted With AFH Application
$
80.00
Quantity
1
2
3
4
5
6
7
8
9
10
Medication Folder And Charting
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Employee Folder
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Medical Incident Folder
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
All Folders
No Customized, No BSP (PROMOTION)
$
190.00
Quantity
1
2
3
4
5
6
7
8
9
10
All Folders Including Custom
No BSP Included.. Customize Includes Adding Your Logo, Business Name, Address, Number of Beds & Type Of Clients, House Description
$
250.00
Quantity
1
2
3
4
5
6
7
8
9
10
Behavioral Service Plan (BSP)
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
Individualized Service Plan (ISP)
editable
$
40.00
Individualized Service Plan (Custom)
customized with name, and logo can be added
$
60.00
Quantity
1
2
3
4
5
6
7
8
9
10
Application Process (Promotion)
You will receive step by step instructions. Only thing you will have to do on your end is create the floor plan and I’ll show you how that looks and then have someone come out to inspect the furnace Some of the requirements are to have an LLC, EIN and Business Account
$
300.00
Quantity
1
2
3
4
5
6
7
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9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
Customized Information
Date Submitted
*
-
Month
-
Day
Year
Date
Signature
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